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Adjunctive Esketamine Effective Strategy for Treatment-Resistant Major Depression

June 15, 2020

Adjunctive esketamine appears effective for patients with major depressive disorder (MDD) who are treatment-resistant or suicidal, a meta-analysis published in The Journal of Clinical Psychiatry concluded.

“Esketamine, the S-enantiomer of ketamine, was recently approved as a rapid-acting intranasal therapy for depression and is currently under development for suicidality,” researchers wrote. “The authors sought to determine the efficacy of adjunctive intranasal esketamine in major depressive disorder.”

Researchers extracted and analyzed data from 5 randomized, double-blind clinical trials that compared adjunctive intranasal esketamine to adjunctive placebo (intranasal saline) in 774 patients with MDD.

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From baseline to endpoint, adjunctive esketamine was significantly more effective than placebo for Montgomery-Åsberg Depression Rating Scale score change, response, and remission, according to the study. Esketamine compared with placebo had a standardized mean difference in MADRS score change of 0.36, a response risk ratio of 1.40, and a remission risk ratio of 1.45.

“Results remained statistically significant regardless of differences in the study sample, fixed vs new/optimized baseline antidepressants,” researchers explained.

“Adjunctive intranasal esketamine for patients with MDD who are either treatment-resistant or acutely suicidal appears to be an effective treatment strategy,” they concluded.

—Jolynn Tumolo


Papakostas GI, Salloum NC, Hock RS, et al. Efficacy of esketamine augmentation in major depressive disorder: a meta-analysis. The Journal of Clinical Psychiatry. 2020;81(4):19r12889.

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